Hongisto Markus T, Nuotio Maria S, Luukkaala Tiina, Väistö Olli, Pihlajamäki Harri K
Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland.
Department of Geriatrics Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
Geriatr Orthop Surg Rehabil. 2019 May 29;10:2151459319853142. doi: 10.1177/2151459319853142. eCollection 2019.
The effect of delays before surgery of 24 hours, 48 hours, and 72 hours on short- and long-term survival has been investigated comprehensively in hip fracture patients, but with controversial results. However, there is only limited evidence for how a threshold of 12-hour delay before hip fracture surgery affects survival.
A prospective observational study of 884 consecutive hip fracture patients (age ≥ 65 years) undergoing surgery was carried out in terms of 30- and 365-day survival. A Cox hazard regression survival model was constructed for 724 patients with American Society of Anesthesiologists score ≥3 with adjustments of age, gender, cognition, number of medications on admission, hip fracture type, and prior living arrangements.
Patients who underwent surgery within 12 hours had better chances of survival than did those with 12 to 24 hours (hazard ratio [HR]: 8.30; 95% confidence interval [CI]: 1.13-61.4), 24 to 48 hours (HR: 7.21; 95% CI: 0.98-52.9), and >48 hours (HR: 11.75; 95% CI: 1.53-90.2) delay before surgery. Long-term survival was more influenced by nonadjustable patient features, but the adverse effect of >48 hours delay before surgery was noticed with HR: 2.02; 95% CI: 1.08-3.80. Increased age and male gender were significantly associated with worse short- and long-term survival.
DISCUSSION/CONCLUSIONS: Early hip fracture surgery within 12 hours of admission is associated with improved 30-day survival among patients with ASA score ≥3. Delay to surgery of more than 48 hours has an adverse effect on 365-day survival, but factors related to patients' comorbidities have a great influence on long-term survival.
在髋部骨折患者中，已全面研究了术前延迟24小时、48小时和72小时对短期和长期生存的影响，但结果存在争议。然而，关于髋部骨折手术前12小时延迟阈值如何影响生存的证据有限。
对884例连续接受手术的髋部骨折患者（年龄≥65岁）进行了一项前瞻性观察研究，观察其30天和365天的生存率。为724例美国麻醉医师协会评分≥3的患者构建了Cox风险回归生存模型，并对年龄、性别、认知、入院时用药数量、髋部骨折类型和先前生活安排进行了调整。
在入院12小时内接受手术的患者比术前延迟12至24小时（风险比[HR]：8.30；95%置信区间[CI]：1.13 - 61.4）、24至48小时（HR：7.21；95% CI：0.98 - 52.9）以及>48小时（HR：11.75；95% CI：1.53 - 90.2）的患者有更好的生存机会。长期生存更多地受到不可调整的患者特征影响，但术前延迟>48小时的不良影响在HR为2.02时被注意到；95% CI：1.08 - 3.80。年龄增加和男性性别与短期和长期生存较差显著相关。
讨论/结论：入院后12小时内进行早期髋部骨折手术与美国麻醉医师协会评分≥3的患者30天生存率提高相关。手术延迟超过48小时对365天生存率有不利影响，但与患者合并症相关的因素对长期生存有很大影响。
